Anterior vaginal retractor for vaginal surgery

ABSTRACT

A triangular base member fits between the flexed thighs and bears downward against the suprapubic area of the lowest part of the abdomen. An adjustable angular extension on the base member has a downturned end portion adjustably connected with an upturned end portion of an L-shaped retractor blade. The blade has a horizontal insertable portion which presses upwardly against the vaginal wall giving the surgeon exposure and operating space and at the same time protecting the urethra and urinary bladder. The inserted portion of the blade underlies the base member and operates in the manner of a clamp wherein the downward pressure exerted exteriorly against the abdomen by the base member applies an upward pressure to the retractor blade. The anterior retractor is used in conjunction with a conventional weighted lower or posterior retractor.

United States Patent [191 Richmond "1., 3,709,215 [451 Jan. 9, 1973 [54]ANTERIOR VAGINAL RETRACTOR FOR VAGINAL SURGERY [22] Filed: Dec. 28, 1970[2]] Appl. No.1 101,911

FOREIGN PATENTS OR APPLICATIONS 179,309 11/1906 Germany ..l28/20 481,7988/1929 Germany" ..;..l28/346 Primary Examiner-Channing L. PaceAttorney-Lee R. Schermerhorn 57] I ABSTRACT A triangular base memberfits between the flexed thighs and bears downward against the suprapubicarea of the lowest part of the abdomen. An adjustable angular extensionon the base member has a downturned end portion adjustably connectedwith an upturned end portion of an L-shaped retractor blade. The bladehas a horizontal insertable portion which presses upwardly against thevaginal wall giving the surgeon exposure and operating space and at thesame time protecting the urethra and urinary bladder. The insertedportion of the blade underlies the base member and operates in themanner of a clamp wherein the downward pressure exerted exteriorlyagainst the abdomen by the base member applies an upward pressure to theretractor blade. The anterior retractor is used in conjunction with aconventional weighted lower or posterior retractor.

2 Claims, 6 Drawing Figures Pmimmm 9 ms 3.7091215 INVENTOR STANLEY M.RICHMOND ANTERIOR VAGINAL RETRACTOR FOR VAGINAL SURGERY BACKGROUND OFTHE INVENTION This invention relates to an improved anterior retractorfor vaginal surgery and is of particular advantage in vaginalhysterectomies.

In a vaginal hysterectomy, separate upper and lower retractors areemployed. The lower retractor is a weighted vaginal speculum whichmaintains its stretching action through gravity. The upper retractorprotects and supports the urethra and urinary bladder and also gives thesurgeon more exposure and operating space.

Heretofore, the upper retractor has usually been an L-shaped right angleinstrument with a long upwardly extending handle which is held in placemanually, although its position is virtually static and requires aconstant force of only a pound or two in an upward direction. The taskof holding the upper retractor is very difficult and tiring because itmust be held in place from 30 minutes to over an hour in some cases andwhen the patient is positioned for vaginal hysterectomy, her thighs andlegs are in the way of an assistant standing to either side of theoperating table. On the other hand, if the assistant holding the upperretractor sits beside the operating surgeon it is still difficultbecause of the crowded conditions resulting from two men sitting andworking between the patient's legs. When the assistant must at intervalsuse both his hands in aiding the surgeon, the task of holding aretractor then temporarily occupies one of the instrument nurses busyhands.

Other types of retractors having both upper and lower blades in a singleinstrument cannot be used for a hysterectomy because the mechanismobstructs the surgeons operating space.

Objects of the invention are, therefore, to provide an improved vaginalretractor which does not obstruct the surgeons operating space, toprovide an upper retractor for the purpose described which will maintainitself in position without being manually held and to provide an uppervaginal retractor which is adjustable to fit the anatomy of the patient.

SUMMARY OF THE INVENTION The present retractor comprises three partswhich are adjustable in relation to each other to fit the anatomy of thepatient. A triangular base member fits between the thighs when they areflexed on the abdomen in the lithotomy position for the performance ofvaginal surgery. This base member bears downward against the superapubicarea of the lowest part of the abdomen. Anadjustable extension on thebase member is of L-shape with a downturned end portion, the extensionbeing made of a malleable material so that its angle may be adjustedwhen the retractor is applied to a particular patient.

The retractor blade is also of L-shape with an upturned exterior portionadjustably connected to the downturned end portion of the extensionmember. The device operates in the manner of a C clamp wherein thedownward pressure of the base member against the exterior surface of theabdomen applies an upward pressure to the retractor blade. This clampingaction holds the retractor securely in place, leaving the assistant andnurse available at all times for their primary duties of aiding andserving the surgeon.

The invention will be better understood and additional objects andadvantages will become apparent from the following description of thepreferred embodiment illustrated on the accompanying drawing. Variouschanges may be made in the details of construction and arrangement ofparts and certain features may be used without others. All suchmodifications within the scope of the appended claims are included inthe invention.

BRIEF DESCRIPTION OF THE DRAWING FIG. is a fragmentary sectional view of'a patient with the thighs flexed on the abdomen in the lithotomyposition, showing the application of the present retractor in theperformance of a vaginal hysterectomy;

FIG. 2 is a view on the line 22 in FIG. 1;

FIG. 3 is a view on the line 3-3 in FIG. 2;

FIG. 4 is a view on the line 4-4 in FIG. 3;

FIG. Sis a view on the line 55 in FIG. 3; and

FIG. 6 is a view on the line 66 in FIG. 1.

DESCRIPTION OF THE PREFERRED EMBODIMENT FIG. 1 shows a step in theperformance of a vaginal hysterectomy as the uterus 10 is being pulledout through the vagina 11 by tenaculum forceps 12. A circular incisionat 13 has severed the connection between the uterus and the vaginalwall. A conventional weighted speculum 14 is used as a lower retractorto pull the lower vaginal wall downward. The upper vaginal wallispressed upward by an upper retractor 20 which embodies the invention.

A flat, generally triangular base member 21 fits between the thighs 22as shown in FIG. 6 and bears against the suprapubic area 23 of thelowest part of the abdomen 24. The pubic bone is indicated at 25, theurinary bladder at 26 and the urethra at 27. In addition to base member21, the upper retractor 20 further comprises an extension member 30 anda blade member 31.

Extension member 30 and blade member 31 are each of L-shape. The upperpart of extension member 30 overlies base member 21 and contains alongitudinal slot 35 which receives a bolt 36 extending through a holein base member 21. A nut 37 and washer 38 secure the members 21 and 30together in adjustable relation. Extension member 30 has a downturnedend portion 40 extending from a curved angle portion 41. Extensionmember 30 is preferably made of stainless steel of suitable thickness toprovide sufficient malleability in the curved portion 41 so that thesurgeon can adjust the angle at 41 to fit the patient.

Blade member 31 is also preferably made of stainless steel but it mayalso be made of a plastic material if desired. Blade member 31 has anupturned exterior end portion 45 having a tapered slot 46 receiving abolt 47 in a hole in the downturned end portion 40 of extension member30. A nut 50 and washer 51 secure the parts 40 and 45 together inadjustable relation. The lower end of slot 46 has a width approximatelyequal to the diameter of bolt 47 while the upper end'of the slot issomewhat narrower, as shown in FIG. 2, in order to retain the parts inassembled relation when the nut is loosened.

End portion 45 is sufficiently resilient to permit bolt 47 to be forcedout of the upper end of slot 46 so that members 30 and 31 may be readilyseparated from each other when desired without removing nut 50. Theupper ends of slot 46 are beveled at 55 so that when the bolt is placedin the position indicated at 47a in FIG. 2, it may be forced back intothe end of the slot 46.

The separability of members 30 and 31 allows the horizontal portion 56of. blade member 31 to be inserted by itself. Then base member 21 andextension member 30 may be assembled on and removed from the blademember 31 repeatedly, if necessary, while adjusting the malleable bendat 41 by trial and error to fit the patient. While this is being done,base member 21 and bolt 36 are adjusted along slot 35 and thisconnection is secured by tightening nut 37. Finally, nut 50 is tightenedat a point in slot 46 that will produce the desired upward pressure onthe inserted portion 56 of the blade member 31.

The inserted portion 56 of the blade member 31 is directly under theupper arm of extension member 30 and base member 21 to form a C clampwhen the parts are properly adjusted. The curved channel-shape of blademember 31 is shown in FIGS. 4 and 5. This provides a concave undersurface on the inserted portion 56 to provide as much operating space aspossible and at the same time, the inserted portion 56 underlies andprotects the urethra 27 and bladder 26 during the operating. The anglebetween the exterior and inserted portions 45 and 56 of the blade ispreferably somewhat less than 90 to aid in keeping the blade inside thepatient and under the public bone 25 when upper traction is applied. Theend 57 of the retractor blade is bluntly pointed for ease of insertioninto the first small opening made in the peritoneum.

Also to aid in keeping the blade inside the patient, the angle at 41 isadjusted to cause the toe end 60 of base member 21 to bear most firmlyagainst the abdomen with heel end 61 slightly elevated as shown inFIG. 1. This places base member 21 and blade portion 56 in nearparallelism and slightly convergent at their ends 60 and 57. The basemember is prevented from sliding to the right by the patients thighs asshown in FIG. 6.

Having now described my invention and in what manner the same may beused, what I claim as new and desire to protect by Letters Patent is:

1. An anterior vaginal retractor comprising a generally triangular basemember adapted to fit between the thighs of a patient, when the thighsare flexed forward toward the patients head, and bear against thesuperapubic area of the lowest part of the abdomen, a malleable andresilient L-shaped extension arm adapted for positioning between thepatients thighs, an adjustable length connection between one end of saidarm and the apex of said triangular base member, an L-shaped blademember having one end adapted to be inserted into the vagina of saidpatient and an exterior end adapted for positioning between the patientsthighs and overlapping the other end of said extension arm, and anadjustable length connection between the overlapping parts of saidextension arm and blade member.

2. A retractor as defined in claim 1, said retractor being adjustable bysaid adjustable connections and by the malleablhty and resillence ofsaid extension arm to cause said base member to bear against the abdomenprimarily at the broad end of said base member which.

is remote from said apex.

1. An anterior vaginal retractor comprising a generally triangular basemember adapted to fit between the thighs of a patient, when the thighsare flexed forward toward the patient''s head, and bear against thesuperapubic area of the lowest part of the abdomen, a malleable andresilient L-shaped extension arm adapted for positioning between thepatient''s thighs, an adjustable length connection between one end ofsaid arm and the apex of said triangular base member, an L-shaped blademember having one end adapted to be inserted into the vagina of saidpatient and an exterior end adapted for positioning between thepatient''s thighs and overlapping the other end of said extension arm,and an adjustable length connection between the overlapping parts ofsaid extension arm and blade member.
 2. A retractor as defined in claim1, said retractor being adjustable by said adjustable connections and bythe malleability and resilience of said extension arm to cause said basemember to bear against the abdomen primarily at the broad end of saidbase member which is remote from said apex.